Health
Advisory
NEW AND UPDATED GUIDANCE RELATED TO NOVEL H1N1 FLU

Delaware Division of Public Health (DPH) would like to share the following new and updated guidance from the Centers for Disease Control
and Prevention (CDC) related to H1N1 influenza with the Delaware community.

As of May 27, 2009 there are 112 laboratory-confirmed cases of H1N1 in Delaware. Of the 112 cases, 95 are in New Castle County, 12 in
Kent County and 4 in Sussex County. There have been two short hospitalizations related to H1N1 but all cases have recovered, or are
recovering, without complications. The ages of the laboratory-confirmed cases ranges from 1 to 41 years.

Influenza illness, including illness associated with the novel influenza A H1N1 virus is ongoing in the United States. The May 22
FluView Report shows that influenza activity is decreasing in the United States; however, levels of influenza-like illness are
higher than normal for this time of year. At this time, the majority of influenza viruses isolated in the United States are now novel
H1N1 viruses.

It’s uncertain at this time how severe this novel H1N1 outbreak will be in terms of how many people infected have severe
complications or death related to novel H1N1 infection. While nation-wide influenza-like-illness surveillance is trending downward,
localized outbreaks are ongoing and it’s likely that such outbreaks will continue over the summer. It’s uncertain how the
novel H1N1 virus will affect the upcoming 2009-2010 influenza season.

The Centers for Disease Control and Prevention continues its response to the novel H1N1 Flu outbreak. CDC's goals continue to be to
reduce the spread and severity of illness and to provide information to assist health care providers, public health officials, and the
public address the challenges posed by this emergency. To this end, CDC continues to develop and update guidance documents and provide
other information.

New on the CDC Web Site:

This interim guidance is specific to correctional facilities to ensure continuation of essential public services and protection
of the health and safety of inmates, staff and visitors in the context of a novel influenza A (H1N1) virus outbreak.

The Epidemiology and Prevention Branch in the Influenza Division at CDC collects, compiles and analyzes information on influenza
activity year round in the United States and produces a weekly report published each Friday called “FluView” at
http://www.cdc.gov/flu/weekly/

Antiviral Use:

As a reminder to clinicians, CDC recommends that influenza antiviral treatment be given to all hospitalized patients with confirmed,
probable, or suspected novel influenza A (H1N1) and any patient with confirmed, probable or suspected novel influenza A (H1N1) who is at
higher risk for seasonal influenza complications. All hospitalized patients should be carefully monitored and treated with antiviral
medications as soon as possible after admission, including patients who seek treatment more than 48 hours after onset of symptoms. The
drugs recommended for treatment are either oseltamivir or zanamivir. The novel H1N1 viruses are resistant to amantadine and rimantadine.

Testing Guidelines:

Not all people with suspected novel influenza (H1N1) infection need to have the diagnosis confirmed, especially if the person resides in
an affected area or if the illness is mild, such as in Delaware.

Clinicians should test persons who have an acute febrile respiratory illness or sepsis-like syndrome
and 1) require hospitalization or 2) are at high-risk for severe disease (as listed below). As always,
clinicians should use their clinical judgment, in addition to this guidance when deciding when to test for novel influenza A (H1N1). The
full CDC recommendation can be found here: http://www.cdc.gov/h1n1flu/identifyingpatients.htm.